Suicide: Warning Signs, Risk Factors, and Prevention Strategies

UPI Study › Courses › Abnormal Psychology › Free lessons › Lesson 12.4 Free with a free account

Suicide: Warning Signs, Risk Factors, and Prevention Strategies

Abnormal Psychology · Chapter 12: Mood Disorders: Types, Origins, and RecoverySection 12.4 · lesson 46 of 9718 min · free with a free account

← Bipolar Spectrum Disorders: Episodes, Patterns, and TreatmentNext lesson: Conceptualizing Stress Disorders and the Physiology and Purpose of Emotions →

Earn 3 college credits for Abnormal PsychologyRecommended for credit by NCCRS · Psychology 180 · self-paced · one payment, lifetime access
Enroll in Abnormal Psychology · $250 →Download the syllabus (PDF)

In this lesson

Written to help you understand prevention, recognition, and how people get help.

  • Use the terminology the field uses, and why it changed
  • Separate risk factors, protective factors, and warning signs
  • Explain why prediction of individuals is not achievable
  • Describe prevention, and the role of a non-professional

Transcript

Everything said in the video, section by section (2,625 words). Read along, or search it.

Mood Disorders: Types, Origins, and Recovery

Suicide: Warning Signs, Risk Factors, and Prevention Strategies

This section is about prevention, recognition, and how people get help. Before anything else, the most important facts in it. Suicidal states are treatable, and they are characteristically temporary. The great majority of people who experience suicidal thoughts do not die by suicide. And most of those who receive support recover. Some listeners will find this material personally affecting. If it becomes difficult, please pause. If you are experiencing thoughts of suicide, please contact a professional or a crisis line now. You do not need to be certain, or in immediate danger, to be entitled to talk to someone.

Read First

Support, Safety, and Four Terms

This material is educational. It is not a basis for assessing anyone's risk, including your own. It contains no instrument, no checklist, and no scoring system. Your course platform carries the regional crisis resource list for your area. This subchapter does not list numbers, because they differ by region, and an out-of-date number is worse than none. Now the vocabulary, which changed deliberately, and for reasons that matter. Suicidal ideation is thinking about suicide. It ranges from passing thoughts that life is not worth living, to sustained and specific thinking. And it is far more common than most people assume. Suicidal behavior refers to actions taken with some intent to end one's life. It is named here as a category, and is not described further anywhere. Death by suicide is the term for a death resulting from such an act. Self-harm without suicidal intent is a distinct phenomenon, named here so the distinction is clear. A person hurts themselves without intending to end their life. Most often to manage overwhelming emotional states, and it has different associations and responses.

Safe Language

Why the Wording Changed

Say died by suicide. Not committed suicide. That verb belongs to crimes and sins, and carries a judgment from when suicide was prosecuted. Many people bereaved this way find the word painful. Never successful, or failed, and never completed. Those words describe an achievement, applied to a death and to a person's survival. Died by suicide, and survived a suicide attempt, are the accurate terms. Do not describe suicide as a solution, an escape, or a release. And do not describe it as understandable in a particular circumstance. Framing of that kind presents it as a reasonable response to difficulty. But equally, do not present it as inexplicable, or as coming from nowhere. That is inaccurate, because antecedents are usually present. And it undermines the case for prevention, since something with no antecedents cannot be prevented. Two things about scale. Suicide is among the leading causes of death worldwide. It accounts for a larger proportion of deaths among younger people, because fewer die of other causes. Comparison between countries is unreliable, and it is worth knowing why. Recorded rates depend on how deaths are investigated, and on what proof a jurisdiction requires. They also depend on how records are kept, and on what consequences follow for a family. So a league table of national rates would measure recording practice as much as anything. What is not in doubt is that this is a major cause of preventable death. And that most people who die by suicide had contact with health services beforehand. Which makes recognition in ordinary clinical settings central to prevention, rather than a specialist concern.

Prediction

Why the Field Moved Away From It

Over recent decades the field made a deliberate shift. Away from predicting which individuals will die by suicide, toward prevention and care. The reason is statistical, and it is worth working through. It is called the base rate problem. When an outcome is rare, even an accurate predictor produces far more false positives than true ones. Take a hypothetical predictor, constructed purely for instruction. Say it is right ninety percent of the time, in both directions. Apply it to an outcome that occurs in a very small fraction of a population. Among the very many people who will not have the outcome, ten percent are still flagged. And because that group is so much larger, look at what the flagged group contains. It consists overwhelmingly of people who were never going to have the outcome. So most people identified as high risk will not die by suicide. And a substantial number of people who do die will not have been flagged. This is not a criticism of any particular tool. It is a property of rare outcomes. No improvement in a predictor removes it. Three conclusions follow. First, categorizing individuals as high or low risk is not a sound basis for deciding who gets care. A low-risk categorization in particular carries false reassurance. Second, the useful question is not who will, but who is suffering and what would help. Third, prevention works at the level of systems and populations as well as individuals.

Factors

Population Associations, and What Can Be Acted On

A risk factor is a characteristic associated with an increased rate of an outcome across a population. That last phrase carries the whole meaning. These are statistical associations. They do not predict what will happen to any individual. Most people with these characteristics, including all of them together, do not die by suicide. The recognized factors, in general terms only. A previous suicide attempt is the strongest single factor identified at the population level. Which is why people who have survived an attempt are a group for whom continuing care matters. Psychological conditions. Chronic pain and chronic physical illness. Recent loss and interpersonal crisis. Social isolation. And access to dangerous means in the environment, stated only in that general form. Now the protective factors, which are not simply the absence of risk factors. Connectedness, strengthened by contact, belonging, and support. Engaged treatment, which depends on access, continuity, and follow-up. Reasons for living, which are frequently what a person raises first themselves. Responsibility to others, which many people name in their own accounts of what held them. Read the modifiability column, because that is why a table like this is worth reading. Most entries name something that can be acted on. Treatment of a psychological condition is the single largest modifiable factor here.

Patterns

Described Without Ranking, and Why

Rates differ between demographic groups, and how that is presented matters. It is given here without ranking, for a specific reason. A table comparing groups invites the reading that membership of a group is itself a risk. That is both inaccurate and stigmatizing. Patterns differ by age, by sex, and by social and economic circumstance. Where differences appear, several explanations compete, and none is established alone. Differences in help-seeking, and in the recognition and treatment people receive. Differences in exposure to adversity, discrimination, isolation, and economic insecurity. And differences in recording practice, of the kind just described. Groups facing sustained discrimination or exclusion show elevated rates in many settings. The explanation that fits the evidence best is the adversity and the exclusion. Not anything about the people themselves. So the clinical implication is the opposite of profiling. Knowing which groups show elevated rates does not identify which individual is struggling. Using it that way reproduces exactly the base rate error we just worked through.

Warning Signs

Found in a Person, Not in a History

A warning sign is an observable change suggesting a person may be in acute distress now. It is a different kind of thing from a risk factor. Confusing the two is one of the commonest errors in this area. A risk factor is stable over months or years. A warning sign is recent, days or weeks. A risk factor tells you about rates across a population. A warning sign tells you something about this person's present state. Neither tells you what will happen. Both indicate that attention is warranted. Now the difference that matters most for a non-professional. Risk factors are found in a history. Warning signs are noticed in a person. The changes most commonly recognized as warning signs include the following. Withdrawal from contact and activities, particularly in someone previously in touch. Giving away possessions that matter, or putting affairs in order without an occasion. A sudden calm after a period of distress, which is easily and dangerously misread as improvement. Expressions of hopelessness. That nothing will change, that this is how it will always be. Expressions of burdensomeness. That others would be better off without them. And talking about suicide, or about not wanting to be here.

Accounts

Each Names Something That Can Be Changed

Several models explain how a person comes into a suicidal state. None of them presents suicide as a reasonable response to anything. The interpersonal theory proposes two states arising together. Thwarted belongingness, the experience of being disconnected from others. And perceived burdensomeness, the belief that one is a burden on the people around one. The word perceived carries weight. That belief is characteristically inaccurate. The evidence supports the constructs as associated with ideation, and is weaker for specific predictions. Hopelessness is the expectation that the future holds no prospect of change. It has the strongest clinical association here, and it is treatable. Psychological pain is the idea that what a person seeks relief from is unbearable mental distress. Its value is that it directs attention to the suffering rather than to the ideation alone. A note on all three. They describe how a state arises. They do not make it reasonable, and understanding a state is not endorsing it. Each is also an argument for intervention, because each names something modifiable. One more fact belongs here, and it may be the most important in the section. People in suicidal states characteristically want both to live, and not to go on as things are. That ambivalence is typical rather than exceptional, and it is what makes intervention possible. There is something in the person on the side of living, and reaching it is what help does.

Myths

Common Beliefs, and What the Evidence Indicates

Six widespread beliefs, and what the evidence actually indicates. First, that asking someone about suicide might put the idea in their head. Asking does not increase ideation or risk. Studies of direct questioning find no such effect, and people frequently report relief at being asked. That myth persists because it is an intuitive fear. And because it gives an anxious person a reason not to ask a frightening question. Second, that people who talk about it are seeking attention and will not act. Talking about it is among the recognized warning signs, and is taken seriously every time. Third, that most people who think about suicide will die by suicide. The great majority do not. The two get conflated in public discussion, and only the deaths are reported. Fourth, that once someone has decided, nothing can be done. Suicidal states are characteristically temporary, and ambivalence is typical. Most people who receive help do not go on to die by suicide. Fifth, that improvement means the danger has passed. A sudden lift after a period of distress is a recognized warning sign rather than reassurance. Sixth, that it happens without warning. Antecedents are usually present. They may not have been visible to any one person, which is not the same thing. Now the single most important practical finding here. A person carrying these thoughts frequently believes they cannot be spoken about. Being asked directly, by someone clearly able to hear the answer, ends that isolation. So ask plainly. Indirect questions invite indirect answers.

Prevention

Three Levels, None Sufficient Alone

Prevention operates at three levels, and they differ in whom they reach. Universal approaches are delivered to a whole population. Public education about mental health and about help-seeking. Teaching people to recognize distress and respond to it. And responsible reporting practice, under which media guidelines govern how these deaths are covered. The rationale is that how the subject is presented publicly affects what people take to be available. That is the observational learning mechanism of five point three, and the effect has been documented. Selective approaches are delivered to groups known to carry higher population-level risk. The limitation is inherent. Identifying a group does not identify which individual is struggling. Indicated approaches are delivered to individuals already in difficulty or in crisis. Crisis lines. Safety planning, which is structured work done with a professional. And continuity of care, with follow-up contact after a crisis or after discharge. Now notice why no level is sufficient alone. Universal work reaches people who will never come to services. Indicated work reaches only those already in contact. One more principle. Reducing access to dangerous items in a person's immediate environment. It is among the better-supported approaches, and nothing specific is named in this course. The reasoning is that suicidal crises are often short-lived. So anything that increases the time between an impulse and an act creates space. Space in which the crisis can pass, and help can arrive.

Treatment

Treat the Condition and the Pain

Suicidal states are treatable. That is stated more than once in this material, and deliberately. It is the fact most at risk of being lost among the risk factors and the warning signs. Psychological approaches with evidence are named at the level of approach. Cognitive-behavioral approaches adapted specifically for suicidal states. Dialectical behavior therapy, developed for people experiencing recurrent self-harm and suicidal behavior. It has the strongest evidence base for that group. And brief structured interventions delivered around a crisis contact. Medication is described by class only, and prescribing decisions rest with a prescriber. Where an underlying condition is present, treating it is a central part of the response. The organizing principle is to treat the condition and the pain, rather than the ideation alone. Consider the difference that makes. A person whose depression is treated, whose circumstances are addressed, and whose isolation is reduced. That person is in a different position from one whose thoughts have been documented and monitored. Two findings about the shape of care matter as much as its content. The period after discharge is one of recognized vulnerability, and transitions are where people are lost. And follow-up contact has evidence behind it. Structured brief contact after a crisis. A call, a letter, a message, made reliably. The mechanism appears to be that the person is reminded somebody is still there. One consequence is worth stating on its own. Not attending is a reason to make contact, not a reason to close a file.

Responding

Notice and Connect. Not Assess or Manage.

Finally, what a friend, family member, or colleague can actually do. The role is to notice and to connect. Not to assess, and not to manage. Notice. Registering a change in someone. Withdrawal, hopelessness, a marked shift in how they are. That is not a judgment about how serious it is, which you are not positioned to make. Ask directly. Name your concern, and ask plainly whether they are having thoughts of suicide. Not hinting. And not asking in a way that signals you would rather hear no. Listen. Let them say it, without argument, reassurance, or hurrying to solve it. Do not promise secrecy. Say, before they tell you, that you cannot keep it to yourself if they are in danger. That is not a betrayal. A promise you would have to break costs more than one you never made. Connect. Help them contact a professional or a crisis line, and stay with them while they do it. Not handing over a number and leaving, and not taking on their care yourself. Then stay in contact afterward, in an ordinary way. The skill being asked of you is narrow and learnable. It requires knowing the person, not knowing the literature. It does not require certainty. Being unsure is the ordinary situation, and a sufficient reason to ask. If someone appears to be in immediate danger, contact emergency services. Or take them to an emergency department, and stay with them. That is the one circumstance in which acting without their agreement is right. Look after yourself as well. Supporting someone in this position is difficult. One last thing. Suicidal states are treatable, and most people who receive help recover. That is the common outcome, and it is the one least often described.

About Abnormal Psychology at UPI Study

Abnormal Psychology (Psychology 180) is a self-paced online course of 97 video lessons in 25 chapters, from the main theoretical perspectives and clinical assessment to anxiety, mood, psychotic and personality disorders, treatment and the law. It carries a NCCRS credit recommendation for 3 semester credits.

Every lesson transcript is free on pages like this one, and the videos are free with a free UPI Study account. Enrolling adds a practice quiz after each lesson, the graded work and final exam that earn the credit, lifetime access, and an official transcript on completion. UPI Study has helped over 130,000 students with college credits. ACE and NCCRS have over 2,100 cooperating colleges that will consider accepting credits; the final decision is with the universities.

Enroll now → Course details Download the syllabus All Psychology and social science courses Every course with PRO →

Why take it here

Why students take Abnormal Psychology with UPI Study

Understand mental health disordersAbnormal Psychology covers how psychological disorders are defined, assessed, explained and treated. It is a core course for psychology majors and useful for nursing, social work, counseling and criminal justice.
Credit at a fraction of the priceThe same 3 credits can cost $750 or more at a US college. Here it is one payment, self-paced, with lifetime access.
Finish your degree soonerTransfer credits reduce the courses you still owe, so you can graduate earlier or lighten a heavy semester.
Strengthen an applicationA completed college-level course on an official transcript shows admissions and scholarship committees you can do the work.
Study on your own scheduleNo start dates, no deadlines. Watch the lessons, practice, and take the final when you are ready.
130,000+students helped with college creditsACE and NCCRS have over 2,100 cooperating colleges that will consider accepting credits; the final decision is with the universities.

Where the credit goes

Universities that work with NCCRS

Abnormal Psychology carries a NCCRS credit recommendation. These universities work with NCCRS; some are UPI Study's signed partners. ACE and NCCRS have over 2,100 cooperating colleges that will consider accepting credits; the final decision is with the universities.

Thomas Edison State UniversityThomas Edison State UniversitySigned partnerUniversity of the PeopleUniversity of the PeopleSigned partnerCharter Oak State CollegeCharter Oak State CollegeSigned partnerStrayer UniversityStrayer UniversitySigned partnerColumbia Southern UniversityColumbia Southern UniversitySigned partnerIndiana TechIndiana TechSigned partnerPenn StatePenn StateWorks with NCCRSSouthern New Hampshire UniversitySouthern New Hampshire UniversityWorks with NCCRSSUNYSUNYWorks with NCCRS +many more cooperating universitiesFind my college →

Find my college → Not listed? Ask Athena in the corner of this page, or book a 15-minute call.

FAQ

Questions students ask us

About Suicide: Warning Signs, Risk Factors, and Prevention Strategies

Why do experts say died by suicide instead of committed suicide?
Experts say died by suicide because committed is the verb used for crimes and sins, and it carries judgment from a time when suicide was prosecuted. Many bereaved people find it painful. Words like successful, failed or completed are also avoided because they frame a death or a survival as an achievement. Died by suicide and survived a suicide attempt are the accurate, non-stigmatizing terms.
What is the difference between a suicide risk factor and a warning sign?
A risk factor is a stable characteristic linked to higher suicide rates across a population, such as a previous attempt, a psychological condition or social isolation, while a warning sign is a recent change suggesting a person may be in acute distress now. Warning signs include withdrawal, giving away possessions, hopelessness, feeling like a burden, talking about suicide, and a sudden calm after distress. Neither predicts what will happen, but both warrant attention.
Why can't suicide be predicted for individual people?
Suicide cannot be reliably predicted for individuals because of the base rate problem. When an outcome is rare, even a highly accurate predictor flags far more people who will never have the outcome than people who will, and it still misses some who do. For this reason the field shifted from labeling people high or low risk toward asking who is suffering and what would help, with prevention working at system, population and individual levels.
How can you help a friend who might be thinking about suicide?
You can help a friend by noticing changes and connecting them to help, not by assessing or managing their risk yourself. Ask plainly whether they are having thoughts of suicide, since asking does not increase risk, then listen without arguing. Do not promise secrecy. Help them contact a professional or crisis line and stay with them while they do. If someone is in immediate danger, contact emergency services.

About the Abnormal Psychology course

How many college credits is Abnormal Psychology?
Abnormal Psychology (Psychology 180) carries a NCCRS credit recommendation for 3 semester credits. ACE and NCCRS have over 2,100 cooperating colleges that will consider accepting credits; the final decision is with the universities.
How much does Abnormal Psychology cost and what is included?
$250, paid once, with lifetime access: all 97 video lessons, a practice quiz after each, the graded work and final exam, and an official transcript when you finish. Students who want several courses choose UPI Study PRO instead.
Which universities accept UPI Study credits?
UPI Study has signed partner agreements with universities such as Thomas Edison State University, University of the People and Charter Oak State College, and works with universities such as Penn State, SNHU and SUNY. ACE and NCCRS have over 2,100 cooperating colleges that will consider accepting credits; the final decision is with the universities. Use "Find my college" on this page to check yours.
How long does Abnormal Psychology take?
It is self-paced with no deadlines. The 97 lessons total about 24 hours of video; most students add reading and practice time and finish in a few weeks to a few months, on their own schedule.
How are the exams done?
Quizzes and assignments are online in the course. The final exam is taken online with proctoring; a person on the UPI Study team checks assignments, usually within two days.
How do my credits reach my college?
When the course shows 100% complete, request the official transcript from your dashboard. It is sent to the college you name, and you can send it to more than one. Check your college first with "Find my college" on this page, or ask Athena.

Ready for the full course? Earn 3 credits in Abnormal Psychology.

97 video lessons, a quiz after each one, and the graded work that earns the credit. Recommended for credit by NCCRS.

Enroll in Abnormal Psychology →Download the syllabusEvery course with PRO →
Abnormal Psychology
3 credits · NCCRSEnroll →